Bypass surgery a safer option than stents for diabetics with clogged arteries

A new study suggests that bypass surgery is a better option for opening blocked cardiac arteries than inserting a stent if the patient is a diabetic. The study found that diabetics who had bypass surgery were about 33 per cent more likely to be alive five years later than those who underwent a procedure to have the blockage opened with a stent. In recent years, the number of cardiac bypass surgeries has declined as doctors have opted for the less invasive stenting procedure, where a tiny tube is threaded into place in the artery from a small incision in the patient's groin. But questions have remained about whether stents are a good option for diabetics, who often have more blockages than other patients. This study, which was led by doctors at Toronto's St. Michael's Hospital, pooled data from eight clinical trials to try to answer the question. The authors say the substantial survival advantage of bypass surgery suggests it should be strongly considered for diabetics needing artery-opening procedures. "It is a pretty significant effect. And it is kind of startling to think that there's still some debate about this when results like these kinds of significant differences are coming out," said Dr. David Latter, a cardiac surgeon and one of the authors of the study

Minimally invasive approach during coronary artery bypass grafting surgery is safe and effective

New research shows that a minimally invasive approach used during coronary artery bypass grafting surgery is safe and effective, despite previous studies that linked endoscopic vein harvesting to a higher mortality rate. The research, published in the August 1, 2012 edition of The Journal of the American Medical Association, was an observational study of more than 235,000 patients included in The Society of Thoracic Surgeons National Database who underwent CABG surgery at 934 participating surgical centers. Investigators compared the three-year outcomes of patients undergoing EVH to the outcomes of patients undergoing the more invasive open vein harvesting (OVH) procedure and found no difference in mortality rates. "This study should alleviate concerns of patients and surgeons raised by past studies, and confirms the superiority of the EVH technique in terms of infection and wound complication rates that makes the minimally invasive approach the preferred method," said senior author Peter K. Smith, MD, Professor and Chief of Cardiovascular and Thoracic Surgery at Duke University in Durham, N.C.

Study sees lower death risk with bypass surgery versus angioplasty for older heart patients

Older patients with clogged heart arteries may have a little lower death risk over time if they get bypass operations instead of angioplasty and stents to fix the problem, new research suggests. It's not the kind of study that gives conclusive evidence, but doctors say it gives a "real world" look at how people fare in ordinary practice. As such, it could tip the balance toward surgery for patients considering the choice, especially because research already shows bypass gives a better and longer lasting result for people with multiple blockages. In a bypass operation, doctors move healthy blood vessels from other parts of the body to detour around clogged arteries supplying blood to the heart. Angioplasty treats the problem via a tube pushed through a blood vessel. A tiny balloon is inflated to flatten the clog and a mesh scaffold, a stent, is placed to prop the artery open. Researchers compared these approaches using records on 190,000 Medicare patients with two or three blockages - the largest study ever of this issue. Death rates were similar one year after either treatment. But after four years, nearly 21 percent of the angioplasty patients had died versus about 16 percent of those who had bypass surgery. Results were discussed at an American College of Cardiology conference in Chicago and published online by the New England Journal of Medicine

Coronary bypass rates drop (USA)

Think of it as bypassing the bypass. U.S. heart patients have been less likely in the past decade to undergo surgery to install a substitute vessel around a clogged coronary artery, with many patients getting a less invasive alternative procedure. Coronary bypass operations decreased by 38 percent per capita in U.S. adults between 2001 and 2008, researchers report in the May 4 Journal of the American Medical Association. Meanwhile, angioplasty procedures - in which a doctor threads a catheter to the heart to open a blockage using a balloon - have stayed nearly constant, with the per capita rate dipping only 4 percent over that time. These catheters nearly always deliver a coated mesh cylinder called a stent, which props open the vessel from the inside. The study's authors calculated the rates by analyzing a national sample more than 5,000 coronary fixes.

For multiple heart blockages, bypass surgery or stents?

"For patients who have several blocked arteries around their heart, the gold standard treatment has long been coronary artery bypass surgery. Now a large clinical trial suggests that drug-coated stents, springy lattice tubes used to prop open clogged arteries, may also work well in patients with multiple blockages. And in some patients, the stents produce equally good results with faster recovery times. The caveats, experts say, are that people with daily or weekly chest pain from advanced coronary artery disease will probably experience slightly better relief from bypass surgery compared to stenting; but they can also count on waiting to get the full benefit of that procedure weeks to months longer than people who get stents. Experts say the study, which is published in The New England Journal of Medicine, brings to light important trade-offs that people with complex coronary artery disease need to weigh before making a decision between the two procedures

Multi-vessel cardiac bypass performed through small single incision

Surgeons at the Methodist DeBakey Heart & Vascular Center, Houston, Texas, perform multiple cardiac vessel bypasses through a single, small incision in the patient's side, reducing pain, recovery time and risk for infection. "This represents a big improvement on older versions of minimally invasive bypass procedures," said Dr. Mahesh Ramchandani, cardiac surgeon at Methodist."By approaching the heart from the patient's side, rather than going in directly over the heart, we can reduce trauma to the patient's ribs and we can see the heart better, which allows us to safely perform multi-vessel bypasses in one minimally invasive procedure," Ramchandani said.
Ramchandani has performed approximately 150 multi-vessel cardiac bypasses using this new approach, a technique he teaches to surgeons in a monthly hands-on, interactive class held in the Methodist Institute for Technology, Innovation and Education (MITIE). He has trained more than 50 surgeons who have come to Methodist from across the world for his expertise

'Leftover' veins from heart surgery yield stem cells

Human veins left over from lifesaving bypass surgery could be a source of "master" cells to help treat future heart problems, say scientists. A University of Bristol team extracted stem cells from the veins, then used them to stimulate new blood vessel growth in mice, Circulation reports. The researchers say their findings could bring treatments to repair damaged heart muscle one step closer. However, a stem cell expert warned that they remained some years away. Stem cells are attractive to medical researchers because they have the ability to produce many different types of human cell, opening up the possibility of repair or renewal for tissues ravaged by disease or injury - BBC

Stenting a good option for left main heart artery

"Twelve-year data on treatment of blockage of the left main heart artery indicate that using a drug-coated stent is an effective alternative to bypass surgery, doctors report. The study of 314 people who underwent the procedure between 1997 and 2008 in Poland supports the findings of a large European trial, which found no difference in the death rate between bypass surgery and angioplasty for the condition, according to a report published online August 19 and in an upcoming print issue of the Journal of the American College of Cardiology by a group of physicians from Poland and the United States"

Protein therapy could eliminate open heart surgery (Israel)

"Researchers from Tel Aviv University have been experimenting to find a way to make cardiac bypass surgery a thing of the past. Dr. Britta Hardy of Tel Aviv University's Sackler School of Medicine had demonstrated how an injected protein might make blood vessels in the human heart regrow, eliminating the need for open heart surgery. According to Dr. Hardy, patients could regrow blood vessels in as little as a few weeks rather than having cardiac bypass, or open heart surgery" - EmaxHealth

Is there long-term brain damage after bypass surgery?

"Brain scientists and cardiac surgeons at Johns Hopkins have evidence from 227 heart bypass surgery patients that long-term memory losses and cognitive problems they experience are due to the underlying coronary artery disease itself and not ill after-effects from having used a heart-lung machine. Researchers say their latest findings explain study results presented last year, which showed that the heart-lung machines - used to pump blood and supply the body with oxygen while the heart is stopped during surgery - did not cause postoperative long-term brain deficits" - Science Centric

Study finds risk from popular heart bypass method (USA)

A common method used in heart bypass surgery spares patients pain and problems upfront but seems to raise their risk of dying or suffering a heart attack over the next three years, a worrisome new study finds. The results could have a big impact - about 450,000 bypass operations are done each year in the United States and 70 percent of them use the method at issue. It involves the way doctors remove a leg vein that is cut up and moved to the chest to create detours around clogged heart arteries. For decades, this was done with a long incision - sometimes groin to toe. That was painful, left a big scar and often led to infections and longer time in the hospital. About 13 years ago, doctors started trying a new way: making small 'porthole' cuts and using a tiny scope and tools to tunnel along the vein and pull it out through the small openings. This quickly became popular as part of a big push toward less invasive surgery. The new study is 'a wake-up call' to rethink the approach, said study leader, Dr. John Alexander of Duke University Medical Center. It found that people who had the small-incision method were significantly more likely to die, suffer a heart attack or need another artery-opening procedure in the following three years. The likely reason is that the vein suffers damage from being pulled out and doesn’t hold up well over time. “This is a very worrisome finding,” said Dr. Timothy Gardner, a heart surgeon at Christiana Care Health Services in Wilmington, Del., and former American Heart Association president. More research is needed to confirm the results, but doctors probably should use the technique more sparingly or handle the vein more carefully when they do pull it out, Gardner said. Results were published in the New England Journal of Medicine

Bypass surgery has long-term benefits for children with Kawasaki disease

Coronary artery bypass surgery provides long-term benefits for children whose hearts and blood vessels are damaged by Kawasaki disease, Japanese researchers report in Circulation: Journal of the American Heart Association. Researchers followed 114 people for up to 25 years who had bypass surgery as children or adolescents (ages 1 to 19) to treat Kawasaki disease - AHA

Pioneering vein op a success (UK)

"A Derby, UK, heart-bypass patient has been one of the first in the East Midlands to benefit from pioneering medical technology. Leslie Partridge feared he was going to be left with a long scar running down his leg when he was taken to hospital for a triple heart-bypass. Surgeons traditionally make a long cut to remove a vein, which runs between the groin and ankle and then use it to improve the blood supply to the heart. This leaves patients vulnerable to infection and means they have to spend longer recovering. But, thanks to new technology, the 71-year-old had just two small cuts made to his right leg. A small camera was then inserted which allowed his surgeon to see inside his leg without cutting it open." - Derby Telegraph

Doctors perform bypass surgery on 20-month-old boy (India)

"Stawan Bijal Shah is now likely to live a normal life after undergoing coronary artery bypass for a rare heart disease in a Delhi hospital, with the 20-month-old possibly becoming the youngest patient in the world to undergo this surgery, doctors said. Shah underwent a coronary artery bypass surgery on Monday after he was found to be suffering from the Kawasaki disease, which damaged his heart. He is now recuperating in the intensive care unit (ICU) of Batra Hospital here where doctors believe that Stawan is the youngest child in the world to undergo such surgery. "Kawasaki is an extremely rare disease among children. It causes thickening and dilation of arteries resulting in severe blockage," said SC Bhan, director cardiac unit, Batra Hospital" - Times of India

Quality measures improve outcomes more than hospital volume alone (USA)

"A new study by researchers at the University of California, San Francisco and Baystate Medical Centre at Tufts University in Massachusetts concludes that patients facing coronary artery bypass surgery should, as a first priority, select a medical facility that has the highest adherence to quality standards. The research team sought to determine how volume among individual surgeons, volume differences between hospitals, and differences in quality of care might influence outcomes following coronary artery bypass surgery. According to the researchers, care from high-volume centres or surgeons has been associated with better outcomes post-operatively, but how volume and quality of care were related has not been well understood. 'You could go to the busiest doctor, as many people do,' said study author Andrew Auerbach, MD, MPH, associate clinical professor of medicine at UCSF and director of research for the Division of Hospital Medicine. 'But how busy the surgeon is may not matter as much as his or her team's adherence to quality measures.' The study, 'Shop for Quality or Volume? Volume, Quality, and Outcomes of Coronary Artery Bypass Surgery,' is published in the 19 May 2009 edition of Annals of Internal Medicine."

The benefits of exercise in cardiovascular disease - and even in heart failure

"Exercise is one of eight preventive measures identified by the European Heart Health Charter and features prominently in the scientific programme of EuroPRevent 2009, the congress of the European Association of Cardiovascular Prevention and Rehabilitation. EuroPRevent 2009 took place in Stockholm, Sweden, on 6-9 May. In new studies presented at the congress exercise is shown to improve markers of heart disease in patients following coronary artery bypass surgery (CABG), to improve event-free survival rate in coronary patients better than stent angioplasty, and to improve markers of disease in heart failure patients, a group usually thought amenable to little more than palliative care" - Medical News Today

Study shows ability available to 'grow' new veins

"There are many times when "new" veins are needed for grafting. Veins are taken from the legs to use in coronary artery bypass surgery routinely. Artificial grafts are sometimes used to create arteriovenous fistulas or shunts in renal patients for use in dialysis. Now there is a way to create a small diameter vascular grafts using the patient's own skin cells. The technique is one developed at Cytograft who funded the study published in the April 25 issue of The Lancet." - EmaxHealth

Heart surgery is just the start (USA)

" Think of the worst traffic jam imaginable, Southern California bad. Imagine congestion choking off movement to all but a trickle, idling automobiles and causing noxious exhaust to build up until only gridlock remains. That was the shape of Robert Elam's heart back in December 2004. Three arteries were completely blocked and two were 90 percent clogged. Blood was still pumping, all right, but the backup was so pronounced that it seeped rather than flowed through his system. Quintuple coronary artery bypass surgery saved Elam's life. But had the 60-year-old Sacramento man not made the conscious, postoperative decision to dedicate himself to a cardiac rehabilitation program, it's doubtful he'd be hale and hearty enough to jump on his road bike and join his wife, Sue, next month on the four-day, 330-mile NorCal AIDS Challenge" - Sacramento Bee

Minimally invasive bypass surgery in Toronto, Canada

Sunnybrook's Schulich Heart Centre became the first centre in Toronto, Canada, to perform minimally invasive, beating-heart bypass surgery to fix clogged arteries and improve blood flow to the heart:

Cardiac "jackhammer" destroys arterial plaque

"Lakewood Ranch Medical Center, Florida, is the first acute care center in the area to offer a new high-tech procedure that can take the place of bypass surgery for some patients. A vibrating catheter blasts its way through stoney plaque deposits the same way a jackhammer cuts through concrete, says Dr. Erick E. Calderon, of Lakewood Cardiovascular Consultants, one of the first doctors in Florida trained to use the new device. Developed by FlowCardia, Inc, the CROSSER Catheter system is revolutionizing treatment of Chronic Total Occlusions or blockages that have completely closed off circulation in arteries in the heart or legs" - Lakewood Ranch Herald